IPAC MANITOBA ANNUAL CONFERENCE DAY............................... MHSAL Guidelines for the Prevention and Control of Antimicrobial Resistant Organisms (AROs)
ARO Working Group Brenda Dyck-IP&C Consultant-MHSAL Molly Blake-WRHA Dr. Lindsay Nicolle-Medical IP&C Consultant-MHSAL Dr. Evelyn Lo-IP&C Physician-WRHA Myrna Dyck-WRHA Monique Liarakos-WRHA Judi Linden-Southern-Santé Sud Ginette LaFreniere-Southern-Santé Sud Fran Little-Prairie Mountain Health Michelle Gibbens-CADTH Dr. Andrew Walkty-DSM Dr. Jared Bullard-Cadham Lab
Revised ARO Guidelines Standardization of IP&C practices for AROs RHAs to develop regional policies/procedures Screening/placement of patients may be enhanced based on epidemiological trends, outbreaks and available resources Guiding principles Limit transmission of AROs Minimize infections with AROs Promote patient safety Achieve goals fiscally responsible Provide evidence based best practice recommendations Updated in a timely matter, as required
OPTIMAL IP&C MEASURES Organizational priority for Routine Practices Comprehensive hand hygiene strategy Education for staff Senior leaders encouraging/supporting education and training Product availability including ABHR at point of care/service delivery Practices audited and shared Compliance rates maintained according to guidelines and standards Communication of rates throughout organization Development/implementation of antimicrobial stewardship Comprehensive environmental control program Policies/procedures Staff education Quality assurance program
Antimicrobial Stewardship Facility/RHA have antimicrobial stewardship in place Key component to preventing antimicrobial resistance Optimize clinical outcomes Minimize unintended consequences of antimicrobial use Infectious Diseases Society of America (IDSA) Society for Healthcare Epidemiology of America (SHEA)
Routine Practices and Additional Precautions Follow Routine Practices and Additional Precautions MHSAL Routine Practices and Additional Precautions: Preventing the Transmission of Infection in Health Care Acute care, LTC, ambulatory care, prehospital care and home care settings Differences between acute care/ltc LTC is resident s home AROs do not endanger health of LTC workers/residents Infected/colonized residents are a potential reservoir for acute care Modifications outlined in MHSAL Routine Practices and Additional Precautions: Preventing the Transmission of Infection in Health Care
MRSA Admission screening for acute care Admitted to or directly transferred from health care facility including personal care homes within or outside Canada within previous 6 months, where they were admitted for more than 24 hours Patient with exposure outside Canada-isolated pending results Patient who received dialysis in another province/country must be isolated if current screening results obtained within 7 days of admission to site are negative Inter-facility Transfer Form indicated admission screening to be done Once MRSA Positive and whose positive status is unknown Patient must be isolated pending results of screening tests MRSA Positive in the flagging system MRSA Contact MRSA Suspect
MRSA Admission Screening for Acute Care Starting dialysis, new to dialysis, new to dialysis unit or returning to the unit after receiving dialysis in another unit Residing in a correctional setting or in a communal living setting (e.g. group home) Long Term Care No admission screening recommended Do not screen a LTC resident upon admission/transfer or return to their PCH/LTC facility
MRSA Surveillance Cultures Anterior nares (both nares-1 swab) Open wounds Incisions Invasive device insertion sites (e.g. central lines) Do not culture closed wounds/lesions/incisions/invasive device Refusal of screening Management of neonates born to MRSA Positive mothers Patients requiring recreational therapy Management of pet/animal visitor Modifications LTC/ambulatory care/home care
VRE VRE is neither more pathogenic nor more virulent than other enterococci Historically Concern VRE would cause deaths, be untreatable or share it s resistance genes 20 years of experience Colonization common but infections infrequent Several effective antimicrobials available Transfer of resistance genes to MRSA seldom observed Extensive Consultation Canadian jurisdictions/change of practice Cost savings/impact Impact Systems in place to monitor Impact-no major issues Improved access to patient beds More time to address other IP&C issues Implemented IP&C related programs with cost savings
CPE CPE Routine screening is not recommended Patients screened must be isolated pending results Admitted or directly transferred from facilities within or outside Canada known to have endemic transmission as identified by IP&C. Must be admitted for more than 24 continuous hours Identified as CPE Positive and no documentation of positive culture. Consult previous facility IP&C for clarification. CPE Suspect CPE Contact
ESBLs ESBLS/AMR-GNB Routine Practices/no Additional Precautions/hand hygiene AMR-GNB Selected GNBs Acinetobacter, Pseudomonas aeruginosa Minimal evidence they are transmissible Contact Precautions Flagging/deflagging not necessary Screening Outbreak-in discussion with IP&C and laboratory Modifications Treatment-consultation with ID Screening Not recommended for contacts or persistent carriage
Community Care Occupational Health No major revisions in community care Criteria for CA-MRSA Hospitalized or in a health care facility for less than 48 hours No previous history of MRSA Not admitted to a hospital or no LTC admission in the past 12 months No reported use of indwelling catheter or medical device in the past 12 months. Occupational Health Based on WRHA OESH/IP&C Protocol HCW exposed to ARO HCW infected with ARO
Surveillance ARO Surveillance Fact Sheets Colonization and infection surveillance VRE-bacteremias Health care associated infection definitions will be used to determine infections Colonizations/infections -analyzed and reported separately CNISP definitions-mrsa/vre Modified CNISP definition-cpe Fact Sheets Generic for patients and health care workers MRSA/VRE/CPE
Conclusions ARO Document Working Group collaboration Streamline document Reflect Current Practice MHHLS RP/AP document VRE Extensive consultation Reduction of measures Completion and posting of document Ongoing revision and updates